Cost–utility of sofosbuvir/velpatasvir versus other direct-acting antivirals for chronic hepatitis C genotype 1b infection in China

• Published in: BMJ open Vol. 10; no. 8; p. e035224
• Main Authors: Yun, Haoya, Zhao, Guoqiang, Sun, Xiaojie, Shi, Lizheng
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 20.08.2020; BMJ Publishing Group
• Series: Original research
• Subjects: Antiretroviral drugs; Antiviral Agents - therapeutic use; Antiviral drugs; Carbamates; China; Cost analysis; Drug Therapy, Combination; Genotype; Health Economics; Hepacivirus - genetics; Hepatitis; Hepatitis C; Hepatitis C, Chronic - drug therapy; Heterocyclic Compounds, 4 or More Rings; Humans; Infections; Interferon; Liver cancer; Liver diseases; Liver transplants; Markov chains; Mortality; Patients; Public health; Ritonavir; Sensitivity analysis; Sofosbuvir - therapeutic use; China; hepatology; public health; health economics
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2019-035224

ObjectiveThis study aimed to estimate the cost–utility of sofosbuvir/velpatasvir (SOF/VEL) compared with other direct-acting antivirals (DAAs) in Chinese patients with hepatitis C virus (HCV).DesignA Markov model was developed to estimate the disease progression of patients with HCV over a lifetime horizon from the healthcare system perspective. Efficacy, clinical inputs and utilities were derived from the published literature. Drug costs were from the market price survey, and health costs for Markov health states were sourced from a Chinese study. Costs and utilities were discounted at an annual rate of 5%. One-way and probabilistic sensitivity analyses were conducted to test the impact of input parameters on the results.InterventionsSOF/VEL was compared with sofosbuvir+ribavirin (SR), sofosbuvir+dasabuvir (SD), daclatasvir+asunaprevir (DCV/ASV), ombitasvir/paritaprevir/ritonavir+dasabuvir (3D) and elbasvir/grazoprevir (EBR/GZR).Primary and secondary outcomesCosts, quality-adjusted life years (QALYs) and incremental cost–utility ratios (ICURs).ResultsSOF/VEL was economically dominant over SR and SD. However, 3D was economically dominant compared with SOF/VEL. Compared with DCV/ASV, SOF/VEL was cost-effective with the ICUR of US$1522 per QALY. Compared with EBR/GZR, it was not cost-effective with the ICUR of US$369 627 per QALY. One-way sensitivity analysis demonstrated that reducing the cost of SOF/VEL to the lower value of CI resulted in dominance over EBR/GZR and 3D. Probabilistic sensitivity analysis demonstrated that 3D was cost-effective in 100% of iterations in patients with genotype (GT) 1b and SOF/VEL was not cost-effective.ConclusionsCompared with other oral DAA agents, SOF/VEL treatment was not the most cost-effectiveness option for patients with chronic HCV GT1b in China. Lower the price of SOF/VEL will make it cost-effective while simplifying treatment and achieving the goal of HCV elimination.